Extensive tissue damage of bovine ovaries after bipolar ovarian drilling compared to monopolar electrocoagulation or carbon dioxide laser

Objective

To evaluate the size of ovarian damage caused by ovarian drilling in polycystic ovary syndrome, the amount of inflicted damage was assessed for the most frequently used ovarian drilling techniques.

Design

Experimental prospective design.

Setting

University clinic.

Patient(s)

Six fresh bovine ovaries per technique.

Intervention(s)

Carbon dioxide (CO₂) laser, monopolar electrocoagulation, and bipolar electrocoagulation were used for in vitro ovarian drilling.

Main Outcome Measure(s)

Amount of inflicted ovarian damage per procedure.

Result(s)

Bipolar electrocoagulation resulted in significantly more destruction per burn than the CO₂ laser and monopolar electrocoagulation (287.6 versus 24.0 and 70.0 mm³, respectively). The damage found per lesion was multiplied by the regularly applied number of punctures per procedure in daily practice (based on the literature). Again, the bipolar electrocoagulation resulted in significantly more tissue damage than the CO₂ laser and monopolar coagulation (2,876 versus 599 and 700 mm³, respectively).

Conclusion(s)

Ovarian drilling, especially bipolar electrocoagulation, causes extensive destruction of the ovary. Given the same clinical effectiveness of the various procedures, it is essential to use the lowest possible dose that works; thus, the first choice should be CO₂ laser or monopolar electrocoagulation.

Key Words: Laparoscopy, ovarian reserve, ovarian drilling, polycystic ovary syndrome